Type of publication:
Conference abstract

Author(s):
*Iftikhar S.; *Green N.J.; *Perks W.

Citation:
American Journal of Respiratory and Critical Care Medicine; 2017; vol. 195

Abstract:
A 77 year old female presented with new onset breathlessness over the previous four weeks. The patient described symptoms of fatigue and one episode of near fainting. Previously she had been active with good exercise tolerance. There was a history of gastro-oesophageal reflux. Medication included omeprazole, zopiclone and citalopram on a regular basis. The patient was a life long smoker, smoking ten cigarettes daily. Alcohol intake was up to 20 units per week. The patient's mother had died of breast cancer and father of pulmonary emphysema. On examination, the patient looked unwell. Blood pressure was 120/60 mm Hg; pulse 120 bpm; and oxygen saturation 97% by pulse oximetry. The patient weighed 60 Kg and denied any weight loss. Cardiovascular, respiratory and abdominal examination was unremarkable. A resting ECG showed sinus tachycardia with first degree heart block. A 24 hour ECG tape and 24 hour blood pressure monitoring showed no significant abnormality. Blood results showed low haemoglobin at 96 g/dl with normal red cell morphology, platelets 675 x 109 /L, white cell count 12.9 x 109 /L (with slightly elevated neutrophils, lymphocytes, monocytes and eosinophils), ESR 88 mm/hour, serum sodium 128 mmol/L, albumin 32 g/L, alkaline phosphatase 135 u/L, AST 55 u/L, ALT 122 u/L, GGT 70 u/L, calcium 2.2 mmol/L and glucose 7.5 mmol/L. A vasculitic screen was negative. Urinalysis revealed proteinuria. A CT scan, that showed marked ground glass change and mosaic attenuation, was discussed at a weekly X-ray meeting. The diagnosis of post viral pneumonitis was made. The patient died suddenly at home two weeks later just prior to a follow up hospital appointment. Post mortem examination revealed interstitial pneumonia (UIP) with focal pulmonary fibrosis and small areas of honeycomb change (fig. 1 & 2). The heart was morphologically normal, but showed myocarditis in which the infiltrate consisted of small T lymphocytes and eosinophil polymorphs (fig. 3). We postulate an association between UIP and lymphocytic myocarditis, which has rarely been described in the literature before.

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